Page 1 of 2WAYNE CENTRAL SCHOOL DISTRICT ● Ontario Center, New York 14520RESIDENCY AFFIDAVIT OF PERSON(S) ACCEPTING CUSTODY & CONTROL OF A STUDENT STATE NEW YORK ( COUNTY OF WAYNE( ss.: TOWN OF (I (we), the undersigned, being duly sworn, depose and say that the student named below is currently residing with me/us on a full-time basis and that the information provided herein is true and complete to the best of my (our) knowledge:1)1/We reside at………………………………………………………………………………………………2) Student’s Name: …………………………………………….Grade (20..-....) ………….Age……….
3) What is your.relationship to this student? Yes No
If NOT, what portion of financial support have you as...
Allowed
None
ctewinkle
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